Health Facility Characteristics and Their Relationship to Coverage of PMTCT of HIV Services across Four African Countries: The PEARL Study

Background: Health facility characteristics associated with effective prevention of mother-to-child transmission of HIV (PMTCT) coverage in sub-Saharan are poorly understood. Methodology/Principal Findings: We conducted surveys in health facilities with active PMTCT services in Cameroon, Cote d’Ivoire, South Africa, and Zambia. Data was compiled via direct observation and exit interviews. We constructed composite scores to describe provision of PMTCT services across seven topical areas: antenatal quality, PMTCT quality, supplies available, patient satisfaction, patient understanding of medication, and infrastructure quality. Pearson correlations and Generalized Estimating Equations (GEE) to account for clustering of facilities within countries were used to evaluate the relationship between the composite scores, total time of visit and select individual variables with PMTCT coverage among women delivering. Between July 2008 and May 2009, we collected data from 32 facilities; 78 % were managed by the government health system. An opt-out approach for HIV testing was used in 100 % of facilities in Zambia, 63 % in Cameroon, and none in Côte d’Ivoire or South Africa. Using Pearson correlations, PMTCT coverage (median of 55%, (IQR: 33–68) was correlated with PMTCT quality score (rho = 0.51; p = 0.003); infrastructure quality score (rho = 0.43; p = 0.017); time spent at clinic (rho = 0.47

Effect of cytomegalovirus infection on breastfeeding transmission of HIV and on the health of infants born to HIV-infected mothers

Cytomegalovirus (CMV) infection can be acquired in utero or postnatally through horizontal transmission and breastfeeding. The effect of postnatal CMV infection on postnatal HIV transmission is unknown

Evaluating Nurses' Implementation of an Infant-Feeding Counseling Protocol for HIV-Infected Mothers: The Ban Study in Lilongwe, Malawi

A process evaluation of nurses’ implementation of an infant-feeding counseling protocol was conducted for the Breastfeeding, Antiretroviral and Nutrition (BAN) Study, a prevention of mother-to-child transmission of HIV clinical trial in Lilongwe, Malawi. Six trained nurses counseled HIV-infected mothers to exclusively breastfeed for 24 weeks postpartum and to stop breastfeeding within an additional four weeks. Implementation data were collected via direct observations of 123 infant feeding counseling sessions (30 antenatal and 93 postnatal) and interviews with each nurse. Analysis included calculating a percent adherence to checklists and conducting a content analysis for the observation and interview data. Nurses were implementing the protocol at an average adherence level of 90% or above. Although not detailed in the protocol, nurses appropriately counseled mothers on their actual or intended formula milk usage after weaning. Results indicate that nurses implemented the protocol as designed. Results will help to interpret the BAN Study’s outcomes

Plasma Micronutrient Concentrations Are Altered by Antiretroviral Therapy and Lipid-Based Nutrient Supplements in Lactating HIV-Infected Malawian Women

Background: Little is known about the influence of antiretroviral therapy with or without micronutrient supplementation on the micronutrient concentrations of HIV-infected lactating women in resource-constrained settings

Adherence to extended postpartum antiretrovirals is associated with decreased breast milk HIV-1 transmission

Estimate association between postpartum antiretroviral adherence and breastmilk HIV-1 transmissio

Pharmacokinetics of zidovudine administered intravenously and orally in children with human immunodeficiency virus infection

Zidovudine pharmacokinetics were determined in 16 children with human immunodeficiency virus infection who were being treated intravenously and orally on an intermittent schedule (every 6 hours). The intravenous doses studied were 80 (n=3), 120 (n=4), and 160 (n=5) mg/m 2/dose, infused over 1 hour. Fourteen patients were monifored after an oral dose of zidovudine at 120 (n=2), 180 (n=7), or 240 (n=5) mg/m 2/dose. Zidovudine was assayed with a reverse-phase high-pressure liquid chromatography method. Zidovudine disapperance after intravenous administration was rapid and blexponential, with half-lives of 14 and 90 minutes and a total clearance of 641±161 ml/min/m 2. The volume of distribution at steady state was 45±28 L/m 2. These pharmacokinetics parameters are very similar to those reported in adults. When administered orally, zidovudine was rapidly absorbed. The fraction of the oral dose that was bioavailable was 0.68±0.25, so that a 50% increment in the dose, in the conversion from intravenous to oral administration, resulted in plasma zidovudine concentrations after oral dosing that were nearly identical to those achieved with the 1-hour intravenous infusion. However, a dose of 180 mg/m 2 given orally every 6 hours maintained plasma zidovudine concentrations in the target range of 1 μmol/L for less than half of the dosing interval. Other schedules, routes of administration, or oral drug formulations may have to be considered if sustained continuous exposure to micromolar zidovudine concentrations is desired

Health facility characteristics by country; PEARL Facility Survey, 2007–2009.

£<p>: <b>Note that this item is not related to HIV, but to maternal and infant health in general.</b></p><p>*Survey was conducted in delivery facilities where antenatal activities are implemented.</p><p>IQR: Interquartile range.</p

Relationship between composite ANC score and PMTCT coverage.

<p>PEARL Facility Survey, 2007–2009.</p

Health facility quality scores and correlation with PMTCT coverage, PEARL Facility Survey, 2007–2009.

<p>ρ: Pearson correlation coefficient, IQR: Interquartile range.</p><p>*p-value for univariate regression models treating coverage as a continuous measure, using GEE to account for correlation due to clustering of facilities within countries.</p

Antenatal care service provision among observed patients, by country; PEARL Facility Survey, 2007–2009^†.

<p>CBS: Cord blood specimens, IQR: Interquartile range, std: standard deviation.</p><p>**full coverage defined as the proportion of HIV-exposed infants in the sample with both maternal nevirapine ingestion (confirmed by cord blood chromatography) and infant nevirapine ingestion (confirmed by direct observation).</p>†<p>For the direct observation patient measures we first calculated the percent observed at each facility among the up to 6 cases and then computed <u>the mean (and standard deviation)</u> of those facility-level percents to get the overall country values shown in the table.</p